Missed insulin dose


How long does my patients' basal insulin last?


Over the course of my more than 30 years as a practicing clinician and primary care educator, I have seen a lot of adult patients with diabetes try to manage their disease and maintain A1C control. Adding basal insulin to my patient's treatment plan can be an effective way to improve glycemic control.    

When I am prescribing a basal insulin, one of the considerations is duration of action. I am encouraged that my choices include basal insulins that last over 24 hours. Patients can get busy or distracted and forget or delay taking their insulin dose. I know most patients with diabetes don’t intend to miss a dose on purpose. But we’re all human, and we make mistakes. That’s why it was nice to learn about a basal insulin with dosing recommendations that allow my adult patients to take their daily dose at any time of the day. If they delay or miss a dose, they should take it as soon as they remember and then return to their regular dosing schedule. They just need to make sure there are at least 8 hours between injections.

Stephen Brunton, MD

Stephen Brunton, MD

  • 30+ years as a practicing physician
  • Executive Vice President for Education for the Primary Care Education Consortium (PCEC)
  • Serves in an editorial role for 8 peer-reviewed journals
  • Former President of the California Academy of Family Physicians and the Association of Family Medicine Residency Directors
  • Winner of the American Medical Writers Association’s John P. McGovern Award for Excellence in Communication

Key features of Tresiba®


Once-daily Tresiba® provides an extended duration of action for patients

42+ hour duration of action1,a
Once-daily Tresiba® can provide patients with a glucose-lowering effect of at least 42 hours.a

aAfter the last of 8 once-daily injections (0.4 units/kg).

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Dosed once daily, and for adults, at any time of day1
Adult patients can take Tresiba® once daily, at any time of day. 

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Flat & stable profile1-3
A smooth and steady release provides continuous coverage for longer than 24 hours.

Adult patients who miss a dose of Tresiba® should inject their daily dose during waking hours upon discovering the missed dose, then continue with their regular dosing schedule. Ensure that at least 8 hours have elapsed between Tresiba® injections.1

Duration of action for Tresiba®

References:

  1. Tresiba [package insert]. Plainsboro, NJ: Novo Nordisk Inc; September 2015.
  2. Heise T, Korsatko S, Nosek L, et al. J Diabetes. 2016;8(1):132-138.
  3. Heise T, Hermanski L, Nosek L, Feldman A, Rasmussen S, Haahr H. Diabetes Obes Metab. 2012;14(9):859-864.



Stephen Brunton, MD


Once-daily Tresiba® was studied at alternating dosing intervals of 8 to 40 hours between doses in adult patients with diabetes.1

As you work with adults with diabetes, you may see patients like these


Read about Sharon's journey with Tresiba®

Do you see patients like Sharon?


Sharon juggles family and work commitments.

With 3 kids and a consulting job, it is sometimes hard for Sharon to stick to a steady routine. Every day is an adventure starring rehearsals and sports practices, client meetings, and deadlines. Sometimes when it’s her turn to drive the carpool, Sharon forgets to take her morning insulin. With Tresiba®, Sharon can take her dose as soon as she gets home, as long as there are at least 8 hours between doses, and then return to her regular dosing schedule the next day.


Learn how Miguel used Tresiba® as an option for around-the-clock blood sugar control

Have you come across patients similar to Miguel?


Miguel is almost always on the road.

Miguel travels nearly every week for his job as an auditor. He feels like he spends more time in hotel rooms than in his own home. For Miguel, it can be a struggle just to remember what time zone he is in. Remembering to take his insulin at the same time every day sometimes gets lost in the shuffle. With Tresiba®, Miguel can take his daily dose later from time to time when he misses his regular dose.

Adult patients who miss a dose of Tresiba® should inject their daily dose during waking hours upon discovering the missed dose, then continue with their regular dosing schedule. Ensure that at least 8 hours have elapsed between Tresiba® injections.1

Hypothetical patients. Individual results may vary. 

AN ENDOCRINOLOGIST'S POINT OF VIEW

Dr Steven Edelman explores the efficacy and safety of Tresiba®


INSULIN PENS AND PRIMARY CARE

Dr Stephen Brunton’s take on prescribing Tresiba® FlexTouch®

Selected Important Safety Information

Contraindications

  • Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients

Warnings and Precautions

  • Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens
  • Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant anti-diabetic treatment may be needed
  • Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening

Indications and Usage

Tresiba® (insulin degludec injection) is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus.

Limitations of Use

Tresiba® is not recommended for treating diabetic ketoacidosis or for pediatric patients requiring less than 5 units of Tresiba®.

Important Safety Information

Contraindications

  • Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients

Warnings and Precautions

  • Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens
  • Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant anti-diabetic treatment may be needed
  • Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening. Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness or renal or hepatic impairment
  • Accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. To avoid medication errors, always instruct patients to check the insulin label before each injection
  • Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products, including Tresiba®
  • As with all insulins, Tresiba® use can lead to life-threatening hypokalemia, which then may cause respiratory paralysis, ventricular arrhythmia, and death. Closely monitor potassium levels in patients at risk of hypokalemia and treat if indicated
  • Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including Tresiba®. Patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of the TZD must be considered

Adverse Reactions

  • Adverse reactions commonly associated with Tresiba® are hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain

Drug Interactions

  • There are certain drugs that may cause clinically significant drug interactions with Tresiba®.
    • Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors
    • Drugs that may decrease the blood glucose lowering effect: atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones
    • Drugs that may increase or decrease the blood glucose lowering effect: alcohol, beta-blockers, clonidine, lithium salts, and pentamidine
    • Drugs that may blunt the signs and symptoms of hypoglycemia: beta-blockers, clonidine, guanethidine, and reserpine

Please click here for Prescribing Information.

 

References:

  1. Tresiba [package insert]. Plainsboro, NJ: Novo Nordisk Inc; August 2018.
  2. Heise T, Korsatko S, Nosek L, et al. J Diabetes. 2016;8(1):132-138.
  3. Heise T, Hermanski L, Nosek L, Feldman A, Rasmussen S, Haahr H. Diabetes Obes Metab. 2012;14(9):859-864.